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Application For Travel Document (Carrier Documentation) : U.S. Citizenship and Immigration Services
Application For Travel Document (Carrier Documentation) : U.S. Citizenship and Immigration Services
Application For Travel Document (Carrier Documentation) : U.S. Citizenship and Immigration Services
Form I-131A
Department of Homeland Security OMB No. 1615-0135
U.S. Citizenship and Immigration Services Expires 02/28/2021
For
USCIS
Document Issued
Use
Transportation Letter Boarding Foil
Only
Document Hand Delivered
By: Date:
(mm/dd/yyyy)
To be completed by an Select this box if Attorney State Bar Number Attorney or Accredited Representative
attorney or accredited Form G-28 or (if applicable) USCIS Online Account Number (if any)
Form G-28I is
representative (if any).
attached.
► START HERE - Type or print in black ink.
Part 1. Information About You 4. Is your current mailing address the same as your U.S.
physical address? Yes No
1.a. Family Name
(Last Name) If you answered "No" to Item Number 4., provide your
1.b. Given Name U.S. physical address in Item Numbers 5.a. - 5.e.
(First Name)
1.c. Middle Name U.S. Physical Address
2. Has your name changed since the issuance of your last 5.a. Street Number
Permanent Resident Card (Form I-551)? and Name
Yes No
5.b. Apt. Ste. Flr.
NOTE: If you answered "Yes" to Item Number 2., attach
evidence of your legal name change with this application. 5.c. City or Town
Current Mailing Address (USPS ZIP Code Lookup) 5.d. State 5.e. ZIP Code
If you answered "Yes" to Item Number 3., provide 4. Applicant's Mobile Telephone Number (if any)
details in the space provided in Part 7. Additional
Information.
5. Applicant's Email Address (if any)
4. Since you were granted permanent residence, have you
EVER filed Form I-407, Abandonment of Lawful
Permanent Resident Status, or otherwise been judged to
have abandoned your status? Yes No Applicant's Declaration and Certification
If you answered "Yes" to Item Number 4., provide details Copies of any documents I have submitted are exact photocopies
in the space provided in Part 7. Additional Information. of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
5.a. Have you EVER been issued a Travel Document?
date. Furthermore, I authorize the release of any information
Yes No from any and all of my records that USCIS may need to
determine my eligibility for the immigration benefit that I seek.
If you answered "Yes" to Item Number 5.a., answer Item
Numbers 5.b. and 5.c. for the last document issued to you I furthermore authorize release of information contained in this
and provide additional details in the space provided in application, in supporting documents, and in my USCIS
Part 7. Additional Information. records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
1.b. Interpreter's Given Name (First Name) Part 6. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
2. Interpreter's Business or Organization Name (if any)
Provide the following information about the preparer.
3.f. Province
3.h. Country
3.f. Province
8.b. Date of Signature (mm/dd/yyyy)
3.g. Postal Code
3.h. Country
Preparer's Statement
7.a. I am not an attorney or accredited representative
but have prepared this application on behalf of the
applicant and with the applicant's consent.
7.b. I am an attorney or accredited representative and
my representation of the applicant in this case
extends does not extend beyond the
preparation of this application.
2. A-Number ► A-
6.a. Page Number 6.b. Part Number 6.c. Item Number
3.a. Page Number 3.b. Part Number 3.c. Item Number
6.d.
3.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number 7.d.
4.d.